Provider First Line Business Practice Location Address:
817 W HARBOR DRVIE
Provider Second Line Business Practice Location Address:
SUITE E
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92101
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-238-1399
Provider Business Practice Location Address Fax Number:
888-371-0059
Provider Enumeration Date:
06/05/2012